Measures of disability can be quite useful to policymakers. Information on prevalence, longitudinal course, and associated socioeconomic status can aid in service planning, resource distribution, and the assessment of enacted policies. The Federal Government collects some relevant information on disability in general, and psychiatric disabilities specifically. Several analyses have concluded, however, that these efforts contribute to a shallow and irregularly updated database.
The National Health Interview Survey (NHIS) is the Federal Government's most regular collection of information on disabilities. Conducted by the National Center for Health Statistics every 2 years, the NHIS collects data concerning existing impairments and activity limitations in noninstitutionalized individuals. Another source of information on disabilities is the Survey of Income and Program Participation (SIPP), conducted by the U.S. Census Bureau since 1983. SIPP is an ongoing study of the economic well-being of U.S. households. As part of the third round of interviews, data were collected on functional limitations, work limitations, and the receipt of Social Security or Veterans disability benefits. Finally, the Current Population Survey (CPS), in which the U.S. Department of Labor collects data on the work status of the population each month, solicits information on disability status in each March supplement.
NHIS, SIPP, and CPS provide limited information on disabilities in general; The data they provide on psychiatric disabilities are even more scant. To augment the Nation's database on disabilities in general and psychiatric disabilities specifically, a special survey to supplement the NHIS is under way. The survey was planned to provide a depth of data heretofore unknown in the field of disability statistics. In addition to information on health status, health care utilization, and activity limitation, the survey includes a variety of questions on impairments (e.g., severity, nature, onset, and duration), receipt of benefits, employment status, work accommodations, earnings, use of vocational rehabilitation services, social interactions, andself-perceptions of disability. The survey also provides an opportunity for longitudinal study. Furthermore, a group of experts developed a new section on psychiatric and cognitive impairments.
To improve the Nation's database on psychiatric disabilities, the Center for Mental Health Services (CMHS) has developed the Uniform Client Data Instrument (UCDI) to assess psychiatric disability. The UCDI incorporates questions on psychiatric symptomatology, daily activities, social functioning, behavioral problems at home and/or work, and substance abuse. The UCDI was incorporated into the National Medical Expenditures Survey (conducted in 1986; data not yet available). More recently, the UCDI was incorporated into a supplement to the NHIS; the data are described in table 3-6 (Not available). While much of the regular CMHS' data collection focuses on service providers and use, a current project--the Longitudinal Client Sample Survey of Outpatient Mental Health Programs--will include information on client functioning. But, Federal support for the collection, analyses, and reporting of national statistics on mental health services and client characteristics has been precarious over the last several years, in that it has not had an official budget of its own. Prior to fiscal year 1989, the program received funds from program management and support accounts at NIMH. Since that time, $5.1 million in fiscal year 1992 and $8.8 million in fiscal year 1993 came from a mental health block grant set-aside.
Information relating to the impact of the ADA on employment is not addressed by any of the ongoing or planned Federal surveys. Data are lacking on the hiring of people with psychiatric disabilities, discrimination and other problems in the workplace, or the attitudes of employers and employees about the ADA and psychiatric disabilities. Indeed, which people with mental disorders are covered by the ADA is not clear. Some analysts have suggested that the EEOC, which now collects information from large employers on the hiring of women and minorities, could monitor such trends among people with disabilities as well, to establish a statistical basis for discrimination. Also, surveys by Federal granting agencies, including the CMHS, NIMH, or the National Institute on Disability and Rehabilitation Research, could incorporate the ADA's definition of disability and ask questions about employment experiences.
Institute of Medicine, Disability in America: Toward a National Agenda for Prevention (Washington, DC: National Academy of Sciences, 1991); E.H. Yelin "The RecentHistory and Immediate Future of Employment Among Persons With Disabilities," The Americans With Disabilities Act: From Policy to Practice, J. West (ed.) (New York, NY: Milbank Memorial Fund, 1991); R. Manderscheid, Director, Division of State and Community Systems Development, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, MD, personal communication, February 1993; M. Adler, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, DC, personal communication, January 1993.